scholarly journals Ventilator Circuits, Humidification and Ventilator-Associated Pneumonia

1996 ◽  
Vol 3 (6) ◽  
pp. 397-402
Author(s):  
Dean Hess
Keyword(s):  
Mechanical Ventilation ◽  
Moisture Loss ◽  
Ventilator Associated Pneumonia ◽  
Ventilator Circuit ◽  
Mechanically Ventilated ◽  
Artificial Airway ◽  
Condensate Formation ◽  
Heated Humidifiers ◽  
Technical Issues ◽  
Heat And Moisture

Technical issues in the care of mechanically ventilated patients include those related to the ventilator circuit, humidification and ventilator-associated pneumonia. Principal issues related to ventilator circuits include leaks and compression volume. Circuit compression volume affects delivered tidal volume as well as measurements of auto-positive end-expiratory pressure and mixed expiredPCO2. Resistance through the ventilator circuit contributes to patient-ventilator dyssynchrony during assisted modes of mechanical ventilation. Adequate humidification of inspired gas is necessary to prevent heat and moisture loss. Common methods of humidification of inspired gas during mechanical ventilation include use of active heated humidifiers and passive artificial noses. Artificial noses are less effective than active humidifiers and are best suited to short term use. With active humidifiers, the circuit can be heated to avoid condensate formation. However, care must be exercised when heated circuits are used to avoid delivery of a low relative humidity and subsequent drying of secretions in the artificial airway. Although pneumonia is a complication of mechanical ventilation, these pneumonias are usually the result of aspiration of pharyngeal secretions and are seldom related to the ventilator circuit. Ventilator circuits do not need to be changed more frequently than weekly for infection control purposes, and the incidence of ventilator-associated pneumonia may be greater with more frequent circuit changes.

scholarly journals Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

2019 ◽  
Vol 36 (1) ◽  
Author(s):  
Elnaz Faramarzi ◽  
Ata Mahmoodpoor ◽  
Hadi Hamishehkar ◽  
Kamran Shadvar ◽  
Afshin Iranpour ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Residual Volume ◽  
Gastric Residual Volume ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Icu Length Of Stay ◽  
Ventilated Patients

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation. Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted. Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group. Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients. How to cite this: Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Elnaz Faramarzi ◽  
Ata Mahmoodpoor ◽  
Hadi Hamishehkar ◽  
Kamran Shadvar ◽  
Afshin Iranpour ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Ventilator Associated Pneumonia ◽  
Residual Volume ◽  
Gastric Residual Volume ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Icu Length Of Stay ◽  
Ventilated Patients

Objectives: The value of gastric residual volume (GRV) monitoring in ventilator-associated pneumonia (VAP) has frequently been questioned in the past years. In this trial, the effect of GRV on the frequency of VAP was evaluated in critically ill patients under mechanical ventilation. Methods: This descriptive study was carried out on 150 adult patients admitted to the intensive care unit over a 14-month period, from October 2015 to January 2017. GRV was measured every three hours, and gastric intolerance was defined as GRV>250 cc. The incidence of vomiting and VAP, GRV, length of mechanical ventilation and ICU stay, APACHE II and SOFA scores, and mortality rate were noted. Results: The mean APACHEII and SOFA scores, ICU length of stay, and duration of mechanical ventilation in the GRV>250ml group were significantly higher than in the GRV≤250 ml group (P<0.05). Also, a significantly higher number of patients in the GRV>250ml group experienced infection (62.3%) and vomiting (71.7%) compared with the GRV≤250 group (P<0.01). The highest OR was observed for SOFA score >15 and APACHE II >30, which increased the risk of GVR>250 ml by 10.09 (1.01-99.97) and 8.78 (1.49-51.58), respectively. Moreover, the increase in GVR was found to be higher in the non-survivor than in the survivor group. Conclusion: Increased GRV did not result in increased rates of VAP, ICU length of stay, and mortality. Therefore, the routine measurement of GRV as an important element of the VAP prevention bundle is not recommended in critically ill patients. doi: https://doi.org/10.12669/pjms.36.2.1321 How to cite this: Faramarzi E, Mahmoodpoor A, Hamishehkar H, Shadvar K, Iranpour A, Sabzevari T, et al. Effect of gastric residual volume monitoring on incidence of ventilator-associated pneumonia in mechanically ventilated patients admitted to intensive care unit. Pak J Med Sci. 2020;36(2):48-53. doi: https://doi.org/10.12669/pjms.36.2.1321 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gradual Reduction of Endotracheal Tube Diameter during Mechanical Ventilation via Different Humidification Devices

1996 ◽  
Vol 85 (6) ◽  
pp. 1341-1349. ◽  
Author(s):  
Maria Cristina Villafane ◽  
Gilda Cinnella ◽  
Frederic Lofaso ◽  
Daniel Isabey ◽  
Alain Harf ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Water System ◽  
Hot Water ◽  
Mechanically Ventilated ◽  
Mean Diameter ◽  
The Mean ◽  
Heat And Moisture

Background Limited data suggest that increased resistance to flow within endotracheal tubes (ETT) may occur in patients whose lungs are mechanically ventilated for more than 48 h, especially when airway humidification is inadequate. This could lead to sudden ETT obstruction or induce excessive loading during spontaneous breathing. Methods Twenty-three such patients were randomly assigned to three types of airway humidifier based on three different working principles: a Fisher Paykell hot water system (n = 7), a Pall BB2215 heat and moisture exchanger (HME) hydrophobic filter (n = 8), and a Dar Hygrobac 35254111 HME hygroscopic filter (n = 8). The decrease in internal pressure along the ETT and the flow rate were measured in each patient every 2 days. An "effective inner diameter" was derived from these measurements and allowed the inner ETT configuration to be monitored. Results On the first day of intubation, the mean diameter was similar in the three groups, and was slightly smaller than the in vitro diameter (mean +/- SD: 7.6 +/- 0.6 mm for Fisher-Paykell, 7.7 +/- 0.4 for Pall, and 7.5 +/- 0.4 for Dar). The mean diameter tended to decrease from day to day. At the end of the study, the overall reduction in mean diameter was significantly greater with the hydrophobic HME (Pall) than with the two other systems (Pall: -6.5 +/- 4% vs. 2.5 +/- 2.5% for Dar and 1.5 +/- 3% for Fisher-Paykell; P &lt; 0.01 with analysis of variance). The same was true of the mean reduction in effective inner ETT diameter expressed per day of ventilation (-1.6 +/- 1.5% per day for Pall vs. -0.5 +/- 0.4% for Dar and -0.2 +/- 0.4% for Fisher-Paykell; P &lt; 0.01). In four patients, the ETT became obstructed and emergency repeated tracheal intubation was required. The Pall HME and the Fisher-Paykell system were being used in three and one patient, respectively. Before obstruction, the reduction in ETT diameter was significantly greater for these four patients than for the remaining 23 patients (7.8 +/- 1.4% vs. 3.1 +/- 4.1%; P &lt; 0.01). Conclusions During prolonged mechanical ventilation, significant alterations in inner ETT configuration occur frequently and are influenced by the type of humidification device used. In vivo monitoring of ETT mechanical properties might be clinically useful.

scholarly journals Mechanical Ventilation Impairs IL-17 Cytokine Family Expression in Ventilator-Associated Pneumonia

2019 ◽  
Vol 20 (20) ◽  
pp. 5072 ◽  
Author(s):  
Fien De Winter ◽  
Bart ’s Jongers ◽  
Kenny Bielen ◽  
Domenico Mancuso ◽  
Leen Timbermont ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Fungal Growth ◽  
Cytokine Response ◽  
Ventilator Associated Pneumonia ◽  
Phagocytic Capacity ◽  
Th17 Response ◽  
Mechanically Ventilated ◽  
Th2 Cytokine ◽  
Th17 Cytokines ◽  
Th1 Cytokines

Mechanical ventilation (MV) is the primary risk factor for the development of ventilator-associated pneumonia (VAP). Besides inducing a pro-inflammatory T-helper (Th)-1 cytokine response, MV also induces an anti-inflammatory Th2 cytokine response, marked by increased IL-4 secretion and reduced bacterial phagocytic capacity of rodent lung macrophages. Since IL-4 is known to downregulate both Th1 and Th17 cytokines, the latter is important in mediating mucosal immunity and combating bacterial and fungal growth, we studied and showed here in a rat model of MV that Th17 cytokines (IL-17A, IL-17F, and IL-22) were significantly upregulated in the lung as a response to different MV strategies currently utilized in clinic. To study whether the increased IL-4 levels are associated with downregulation of the anti-bacterial Th17 cytokines, we subsequently challenged mechanically ventilated rats with an intratracheal inoculation of Pseudomonas aeruginosa (VAP model) and showed a dramatic downregulation of IL-17A, IL-17F, and IL-22, compared to animals receiving the same bacterial burden without MV. For the studied Th1 cytokines (IFNγ, TNFα, IL-6, and IL-1β), only IFNγ showed a significant decrease as a consequence of bacterial infection in mechanically ventilated rats. We further studied IL-17A, the most studied IL-17 family member, in intensive care unit (ICU) pneumonia patients and showed that VAP patients had significantly lower levels of IL-17A in the endotracheal aspirate compared to patients entering ICU with pre-existing pneumonia. These translational data, obtained both in animal models and in humans, suggest that a deficient anti-bacterial Th17 response in the lung during MV is associated with VAP development.

scholarly journals Comparative study of incidence, risk factors, etiological agents and outcome of early and late ventilator associated pneumonia in paediatric intensive care unit at a tertiary care centre

2018 ◽  
Vol 5 (3) ◽  
pp. 708
Author(s):  
Preeti Malhotra ◽  
Naresh Kumar ◽  
Karuna Thapar ◽  
Amanjeet Kaur Bagga
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Paediatric Intensive Care Unit ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Acinetobacter Baumanii ◽  
Gram Negative ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Background: Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection in the paediatric intensive care unit (PICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate, risk factors and bacteriological profile and outcome of early and late ventilator associated pneumonia in PICU.Methods: The study was conducted from December 2015 to November 2017 in which 89 children beyond 1 year of age were ventilated for more than 48 hours of which those who developed VAP as per CDC criteria were enrolled in the study. The endotracheal secretions were collected, processed and recorded as per standard microbiological methods. Statistical associations were further evaluated between various parameters of VAP and time of development of VAP.Results: Of all the mechanically ventilated patients, 33.7% developed VAP. Incidence of Early VAP was 23.3% and that of Late VAP was 76.67%. Duration of mechanical ventilation and re-intubation were significantly associated with the time of development of VAP. Micro-organisms identified by culture, involved in the aetiology of VAP were: gram-negative bacteria in 74.9% and gram-positive bacteria in 25.1%. The overall mortality rate was 43.33%.Conclusions: Re-intubation and duration of mechanical ventilation are a significant risk factor for development of late VAP. Overall the most common Gram-negative bacteria associated with VAP was Acinetobacter baumanii. The most common isolate in early VAP was Acinetobacter baumanii whereas infections by Pseudomonas and E. coli are common in late VAP. population.

scholarly journals Complications of mechanical ventilation

2011 ◽  
Vol 139 (9-10) ◽  
pp. 685-692
Author(s):  
Biljana Draskovic ◽  
Goran Rakic
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Lung Damage ◽  
Mechanically Ventilated ◽  
Artificial Airway ◽  
Organic Systems ◽  
Vital Functions ◽  
Care Workers ◽  
Inflammatory Processes ◽  
Ventilation Of The Lungs

Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1) airway-associated complications; 2) complications in the response of patients to mechanical ventilation; and 3) complications related to the patient?s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient?s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma), it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma) and may cause subtle damages due to the activation of inflammatory processes (biotrauma). Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

scholarly journals Investigating the Role of Subglottic Secretions Suctioning in the Prevention of ‎Ventilator Associated Pneumonia in Patients With Invasive Mechanical ‎Ventilation

2019 ◽  
Vol 11 (6) ◽  
pp. 111
Author(s):  
Iyad Abbas Salman ◽  
Waleed Ibraheem Ali ◽  
Amir Ibrahim Moushib ◽  
Hayder Adnan Fawzi
Keyword(s):  
Mechanical Ventilation ◽  
Endotracheal Tube ◽  
Invasive Mechanical Ventilation ◽  
Tracheal Aspirate ◽  
Ventilator Associated Pneumonia ◽  
Mechanically Ventilated ◽  
Subglottic Secretion ◽  
Radiological Features ◽  
Ventilated Patients

BACKGROUND: development of ventilator associated pneumonia (VAP) leads to &lrm;prolonged hospital stay, increased health care cost, and mortality rates. Subglottic &lrm;secretion drainage through a dedicated endotracheal tube has been advocated as a mean &lrm;to decrease the incidence of VAP and thereby assisting in &lrm;the decrease of morbidity associated with invasive mechanical ventilation.&lrm; OBJECTIVE: Investigate the role of subglottic secretion suctioning in the prevention of VAP in mechanically ventilated patients in intensive care unit.&lrm; METHODS: A cross sectional study done in the intensive care unit of Ghazi Al-Hariri &lrm;hospital for surgical specialties in medical city complex, 30 patients who &lrm;are in need for invasive mechanical ventilation were intubated with endotracheal tube &lrm;that have special port for subglottic secretion suctioning. Daily monitoring of patients &lrm;clinical and radiological data to detect features of VAP was &lrm;done, and if there was a suspicion of pneumonia, culture for tracheal aspirate performed &lrm;to confirm diagnosis.&lrm; RESULTS: &lrm;Patient&rsquo;s age was 37.1 &plusmn; &lrm;&lrm;15.39 years, the highest proportion of study patients was found in &lrm;age group &lt; 30 and &lrm;&lrm;30&ndash;49 years (40% in &lrm;each group), most of the patients were males (70%) with a male to female ratio of &lrm;&lrm;2.33:1&lrm;&rlm;, &rlm;Subglottic secretion suctioning lead to reduction in VAP by relative risk (95%CI) of &rlm;&lrm;0.167 (0.045&ndash;0.559)&lrm;&rlm;, p-&rlm;value = 0.001. &rlm;Twenty eight patients didn&rsquo;t show any sign, symptoms &lrm;or radiological features suggesting a &lrm;diagnosis of pneumonia while two patients developed &lrm;features of pneumonia (suggestive signs and &lrm;symptoms, radiological features and &lrm;positive culture of tracheal aspirate).&lrm; CONCLUSION: the use of endotracheal tube with subglottic &lrm;secretions suctioning can have a role in the prevention of VAP in mechanically ventilated patients.&lrm;

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